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\nMedical peripherals can combine with a smartphone to create the function of an ultrasound machine, an EKG reader, or an otoscope, to name just a few diagnostic devices. But without buying anything extra, nearly every consumer mobile device has a camera of some sort built-in. That means that when it comes to dermatology, most patients have, right in their pockets, the tools to gather much of the data their doctor needs to treat them.<\/p>\n
Teledermatology was a major topic at the American Telemedicine Association conference in Austin, Texas, in particular the \u201cstore and forward\u201d kind, which is teledermatology where patients take pictures and send them to their dermatologist, who sends a treatment plan back \u2014 rather than conducting the examination in realtime. Just as the country is experiencing a dermatologist shortage, sufficiently high quality cameras are becoming widespread enough to support remote skin care.<\/p>\n
At ATA, a number of direct-to-consumer teledermatology providers spoke about their different approaches to teledermatology. Mark Seraly represented DermatologistOnCall<\/a><\/strong>, an online platform that connects patients to dermatologists, David J. Wong spoke on behalf of Direct Dermatology<\/a><\/strong>, an online dermatology practice, and Ryan Hambley talked about startup YoDerm<\/a><\/strong> which hones in on diagnosis, treatment and prescription for acne specifically. Jeff Benobio, a Kaiser Permanente dermatologist, rounded out the panel, but as an integrated healthcare system Kaiser Permanente\u2019s stood out as the only one who wasn\u2019t thinking in terms of D2C.<\/p>\n \u201cDermatology is all about what it looks like,\u201d said Seraly, noting that most of a dermatologist\u2019s early training is making diagnoses from photographs. \u201cEvery dermatologist, I am confident, when they leave their training they are already naturally trained teledermatologists.\u201d<\/p>\n The presenters agreed that patients\u2019 cameras are good diagnostic tools.<\/p>\n \u201cWe\u2019ve been surprised, we\u2019ve been amazed that patients send good, high-quality photos. Patients know that if it looks bad to them, it\u2019s not going to look any better to me, as a dermatologist,\u201d said Wong. He added that there are limits to teledermatology, and that they will send patients to in-person specialists for certain procedures like a full body skin check, but that\u2019s a minority of cases.<\/p>\n With a shortage of dermatologists nationwide that\u2019s projected to worsen, teledermatology allows existing doctors to see more patients.<\/p>\n \u201cAccess is a huge problem,\u201d said Wong. \u201cDelayed diagnosis in melanoma is something we see all the time, because they can\u2019t get in to see us. We have a great opportunity to really define the ways and best practices to provide this care.\u201d<\/p>\n Services like Wong\u2019s Direct Dermatology give patients detailed instructions to photograph their skin complaints. The doctor can study the securely forwarded photograph before visiting with the patient remotely. Depending on what state they\u2019re based in, teledermatologists can prescribe most medications (Hambley said the only acne medications his dermatologists don\u2019t prescribe are isotretinoin and birth control). Visits actually last longer than many in-person dermatology check-ups, and they produce a record future complaints can be compared against \u2014 something that doesn\u2019t always happen in the clinic.<\/p>\n One problem with online dermatology is that it represents a change to how people think of consuming healthcare. Seraly, Wong, and Hambleys\u2019 services are entirely online, and they rely on patients thinking to look online for their dermatology care in the first place.<\/p>\n \u201cOne of the big issues for us is educating the market,\u201d Hambley said. \u201cThere arent very many people out there searching the internet for these telemedicine services. For services like YoDerm, that\u2019s definitely a big barrier.\u201d YoDerm charges patients $59 per visit and doesn\u2019t accept any insurance. Accepting insurance can be a tricky proposition for teledermatologists \u2014 according to Dr. Marc Goldyne, a UCSF Medical Center dermatologist who also spoke at the conference, store and forward is only explicitly covered by insurance in seven states.<\/p>\n Anna Orlowski, a lawyer who spoke on another panel at ATA, said that so far there have been no reported cases of a malpractice lawsuit related to teledermatology specifically, and the liability for a teledermatologist is likely low, since the law considers dermatology to be a low-risk specialty. Nonetheless, YoDerm provides malpractice insurance as part of its compensation of independently contracted dermatologists.<\/p>\n Benabio of Kaiser Permanente represents an alternate model for teledermatology, one tied to a more comprehensive health system. Benabio shared how \u201cstore and forward\u201d telemedicine works in context at Kaiser Permanente.<\/p>\n \u201cSo [a primary care doctor] has a patient who comes into his office with rashes,\u201d he said. \u201cHe tries all the regular stuff, he\u2019s getting nowhere. So he takes a picture, sends it to me, I can look at it, say \u2018Duh, it\u2019s pityriasis rosea,\u2019 you knew that. The value proposition is: I just took a regular primary care doctor and made him into a \u2018Super Doc\u2019.\u201d<\/p>\n But Benabio thinks startups like Direct Dermatology, DermatologistOnCall, and YoDerm have a big role to play in keeping patients with easily treatable skin conditions out of the larger healthcare system in the first place, and reducing the burden on dermatologists in the system.<\/p>\n \u201cOne of the biggest challenges is for healthcare to get the hell out of the way and let these entrepreneurs solve this,\u201d he said.<\/p>\n Each of the startups on the panel used technology and photographs as an intermediary for trained dermatologists. But a number of app startups like Skin Scan and Mole Detective, arguably take remote diagnosis of skin conditions one step further, by using an algorithm to give users feedback on whether a skin lesion might necessitate a visit to the doctor or not<\/strong><\/a>.\u00a0These controversial consumer apps were the subject of some debate at the recent congressional hearings on mobile health regulation<\/a><\/strong>.<\/p>\n Until those apps have been clinically proven and FDA cleared, teledermatology remains a much safer proposition.<\/p>\n<\/div>\n<\/div>\n<\/div>\n [\/et_pb_text][et_pb_divider admin_label=”Divider” color=”#98c137″ show_divider=”on” divider_style=”dashed” divider_position=”top” hide_on_mobile=”on”] [\/et_pb_divider][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n